NEW YORK (Reuters Health) – Basic clinical information can identify individuals at high risk of developing diabetes within 10 years, and adding some lab values identifies those at very high risk. U.S. researchers report the development of the two scoring systems in the June 2 issue of Annals of Internal Medicine.

“Perhaps the most appealing feature of our two scoring systems is their ease of use in a clinical or public health setting,” Dr. Henry S. Kahn and colleagues from the Centers for Disease Control and Prevention, Atlanta, Georgia, write. “Through the adoption of integer point scores, their algorithms are simple enough to be calculated using only a pencil and paper.”

The scoring systems were derived and validated using 14.9 years of longitudinal data from 12,729 participants in the Atherosclerosis Risk in Communities study who were between 45 and 64 years old at baseline. A derivation sample included 9587 of the subjects, while the other 3142 formed the validation group.

Approximately three-quarters of the cohort completed 10 years of follow up, and 18.9% of the baseline cohort members developed diabetes at some point during follow-up.

The basic scoring system developed by Dr. Kahn’s team includes increased weight and waist circumference, age 55 or older, black race, short stature, hypertension, rapid pulse, smoking history, and family history of diabetes.

The enhanced scoring system includes these same variables plus elevated fasting glucose and abnormal results on other analytes commonly assessed in a fasting blood sample (triglyceride, HDL cholesterol, and uric acid level).

“When applied to the validation sample, ascending quintiles of the basic system were associated with a 10-year incidence of diabetes of 5.3%, 8.7%, 15.5%, 24.5% and 33.0%, respectively,” the researchers report. “Quintiles of the enhanced system were associated with a 10-year incidence of 3.5%, 6.4%, 11.5%, 19.3%, and 46.1%.”

“Sequential application of the basic and enhanced scoring systems…would help to bring adults at greatest need into appropriate modes of preventive care,” Dr. Kahn and colleagues conclude.

In a related editorial, Dr. William H. Herman of the University of Michigan, Ann Arbor notes that while the proposed scoring systems have several limitations, the models “clearly advance the cause of identifying persons at risk for diabetes who are likely to benefit from focused clinical interventions.”

Reference:
Ann Intern Med 2009;150:741-751,812-814.